Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.
Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.
Laryngoscope. 2020 Apr;130(4):893-898. doi: 10.1002/lary.27988. Epub 2019 Apr 9.
OBJECTIVES/HYPOTHESIS: To evaluate the "July effect," as a possible risk factor for perioperative complications in otolaryngology microvascular reconstruction during the transitional period in the academic calendar.
Retrospective database review.
Microvascular reconstruction outcomes in the National Surgical Quality Improvement Program (2005-2016) database were compared between the first academic quarter (July-September) to the last academic quarter (April-June). The primary outcome was 30-day morbidity, and secondary outcomes included 30-day mortality, operative complications, or postoperative adverse events.
There were 612 and 580 patients who underwent microvascular reconstruction during the first and last academic quarters, respectively. There was no significant difference between the 30-day mortality between the first academic quarter (1.5%) and the last academic quarter (0.7%) (P = .194). There was no difference in 30-day morbidity (47.9% vs. 49.5%, P = .586), operative complications (wound disruption, P = .151; bleeding, P = .526; operative time, P = .162), or postoperative adverse events (deep vein thrombosis, P = .460; pneumonia, P = .737; reintubation, P = .201; pulmonary embolism, P = .452; ventilation for >48 hours, P = .769; acute renal failure, P = .500; urinary tract infection, P = .693; unplanned readmission, P = .202; and mean length of stay, P = .497).
There appears to be no July effect in microvascular reconstruction. Further studies should identify the mechanisms that preserve the safety of this operation year-round for application to other areas of medicine who have observed the July effect.
NA Laryngoscope, 130:893-898, 2020.
目的/假设：评估“七月效应”是否是耳鼻喉科微血管重建术围手术期并发症的一个可能风险因素，这种效应在学术日历的过渡期出现。
回顾性数据库研究。
对国家手术质量改进计划（2005-2016 年）数据库中的微血管重建结果进行分析，比较第一学术季度（7 月至 9 月）和最后一个学术季度（4 月至 6 月）的情况。主要结果是 30 天发病率，次要结果包括 30 天死亡率、手术并发症或术后不良事件。
第一学术季度和最后一个学术季度分别有 612 例和 580 例患者接受了微血管重建。第一学术季度（1.5%）和最后一个学术季度（0.7%）的 30 天死亡率之间无显著差异（P =.194）。30 天发病率（47.9%比 49.5%，P =.586）、手术并发症（伤口破裂，P =.151；出血，P =.526；手术时间，P =.162）或术后不良事件（深静脉血栓形成，P =.460；肺炎，P =.737；再插管，P =.201；肺栓塞，P =.452；通气>48 小时，P =.769；急性肾衰竭，P =.500；尿路感染，P =.693；非计划再入院，P =.202；和平均住院时间，P =.497）均无差异。
微血管重建中似乎没有“七月效应”。进一步的研究应确定保护该手术全年安全性的机制，并将其应用于其他观察到“七月效应”的医学领域。
NA 喉科学，130：893-898，2020。
